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Rapid atropine synthesis for the treatment of massive nerve agent exposure
Richard J Kozak1, Scott Siegel, Jim Kuzma
1Department of Emergency Medicine, Mission Hospital Regional Medical Center, Mission Viejo, CA, USA. rjkozak@uci.edu
Study Objective:
We developed and tested a protocol for compounding a large volume of injectable atropine from powder. The resulting protocol could be used by hospitals to rapidly use large amounts of stockpiled atropine.
Methods:
The protocol required 2 g of solid (powdered) atropine and 1 L of normal saline solution. The solution was filtered and mixed. One hundred syringes were filled by using a standard syringe-batching system. Modifications, including hand filling, were studied to reduce the time required to synthesize one hundred 3-mL syringes.
Results:
A single pharmacist was able to reconstitute one hundred 6-mg atropine syringes in 29 minutes using the batching system. The quickest method for a single pharmacist filling syringes by hand was 34 minutes. The cost to the hospital for 5 g of powdered atropine was 11 dollars versus 5,000 dollars for prefilled syringes.
Conclusion:
Large quantities of atropine syringes can be compounded from a powdered form in a timely manner. Additionally, there is a significant cost advantage to using powdered atropine as a hospital stockpile.